33 research outputs found
Pain treatment in children
LijeÄenje boli djece specifiÄno je zbog anatomskih, fizioloÅ”kih i psiholoÅ”kih razlika koje postoje izmeÄu djece i odraslih. I u djeÄjoj dobi razlikujemo akutnu i kroniÄnu, malignu i nemalignu, nocicepcijsku i neuropatsku bol. Intenzitet boli mjerimo skalama odgovarajuÄima za dob i kognitivni razvoj djeteta. Akutna bol u djeÄjoj dobi ima zaÅ”titnu ulogu i lakÅ”e ju je prepoznati. SusreÄemo je u hitnom prijmu, u poslijeoperacijskom tijeku, pri invazivnim dijagnostiÄkim i terapijskim postupcima. KroniÄna bol djeÄje dobi nemalignog je i malignog podrijetla; potonja je somatska, visceralna ili neuropatska, nastaje od progresije tumora, ali i od lijeÄenja. Boli malignog podrijetla lijeÄe se prema trostupanjskoj ljestvici SZO-a, uz titraciju, rotaciju i konverziju opioida. KroniÄna bol nemalignog podrijetla obuhvaÄa muskuloskeletnu bol, glavobolje, tenzijske ili migrenske i neuropatsku bol razliÄitih uzroka. Bol u djeÄjoj dobi lijeÄi se farmakoloÅ”kim i nefarmakoloÅ”kim metodama, na naÄelima preemptivne i multimodalne analgezije.Differences in anatomy, physiology and psychology between children and adults make paediatric pain treatment specific. Acute and chronic pain, malignant and non-malignant chronic pain, nociceptive and neuropathic pain also occur in childhood. The intensity of pain is measured by using scales appropriate for a childās age and cognitive development. Acute pain in children has a protective function and its assessment is easy in emergency departments, and in postoperative, invasive diagnostic and therapeutic settings. The origin of chronic paediatric pain is both malignant and non-malignant; the latter has somatic, visceral and neuropathic components, originating from tumour progression and chemo- and irradiation therapy. Malignant pain is treated in line with the WHOās three-step model, with titration, rotation and conversion of opioids. Chronic non-malignant pain includes musculoskeletal pain, tension and migrainous headaches, and neuropathic pain of different origins. Pharmacological and non-pharmacological pain treatment in children is based on pre-emptive and multimodal principles of therapy
SOME PEDIATRIC SYNDROMES WITH DIFFICULT AIRWAYS IN NESTHESIA INDUCTION
MeÄu velikim brojem pedijatrijskih sindroma ima nekih kod kojih je problem otežano osiguranje diÅ”nog puta. Defi nicija otežanog diÅ”nog puta ukljuÄuje probleme ventilacije kroz masku, poteÅ”koÄe kod laringoskopije ili kod intubacije traheje. NajÄeÅ”Äi problemi otežanog diÅ”nog puta kod djece s pedijatrijskim sindromima uzrokovani su deformacijama glave, maksilarnom ili mandibularnom hipoplazijom, malim ustima, ograniÄernim usnim otvorom. velikim jezikom, mikro- i retrognatijom i ograniÄenom pokretljivoÅ”Äu vrata. Pedijatrijski sindromi s teÅ”koÄama diÅ”nog puta su: Alpertov sindrom, Beckwith-Wiedemannov
sindrom, sindrom Cornelia De Lange, ahondroplazija, sindrom CHARGE, sindrom cri du chat, Crouzonov sindrom, Pffeiferov sindrom, Downov sindrom, Hunterov sindrom, Hurlerov sindrom, Goldenharov sindrom, Klippel-Failov sindrom, Pierre Robinov sindrom, Treacher Collinsov sindrom i epidermolysis bullosa. Uz svaki sindrom prikazana su pomagala za osiguranje diÅ”nog puta, tj. supraglotiÄna pomagala kao Å”to je laringealna maska za diÅ”ne puteve, stilet uvodnik za intubaciju ā gumirana elastiÄna bužija, stilet sa svjetlom, fi beroptiÄki stilet, fl eksibilni fi beroptiÄki bronhoskop, indirektni rigidni laringoskop i videolaringoskop. Ovaj pregled pedijatrijskih sindroma s otežanim osiguranjem diÅ”nog puta kao i pregled pomagala za postupke osiguranja diÅ”nog puta namijenjen je anesteziolozima koji periodiÄki ili svakodnevno anesteziraju djecu.Out of a large number of pediatric syndromes, some pose a problem of diffi cult pediatric airway. The defi nition of diffi cult
airway includes problems with facemask ventilation, diffi culties with laryngoscopy or with tracheal intubation. The most
common diffi cult airway problems in children with pediatric syndromes are caused by head deformities, maxillary or mandibular
hypoplasia, small mouths, limited mouth opening, big tongues, micro- and retrognathy, and limited neck mobility.
Pediatric syndromes with diffi cult airways include Apert sy, Beckwith-Wiedemann sy, Cornelia De Lange sy, achondroplasia,
CHARGE sy, Cri du chat sy, Crouzon sy, Pffeifer sy, Down sy, Hunter sy, Hurler sy, Goldenhar sy, Klippel- Feil sy, Pierre Robin
sy, Treacher Collins sy and epidermolysis bullosa. Rescue devices for diffi cult pediatric airway management are shown along
with each syndrome, e.g., supraglottic devices such as laryngeal mask airway, intubating introducer ā gum elastic bougie,
lighted stylet, fi beroptic stylet, fl exible fi beroptic bronchoscope, indirect rigid laryngoscope and video laryngoscope. This
overview of pediatric syndromes with diffi cult airways, as well review of devices for diffi cult pediatric airway management is
intended for anesthesiologists who anesthetize children daily or periodically
Hirschsprungās Disease and Rehbeinās Procedure ā Our Results in the Last 30 Years
Hirschsprungās disease is congenital anomaly of the intestine and Harald Hirschsprung gave the first description of
this disease1. The aim of this follow-up study was to evaluate the results of Rehbeinās procedure in the treatment of
Hirschsprungās disease in the last 30 years in Childrenās Hospital Zagreb. Hirschsprungās disease is congenital intestinal
aganglionosis as the results of arrested fetal development of the myenteric nervous system. Hirschsprungās disease is
affecting between 1:5000 to 1:8000 live births. A total of 124 children underwent Rehbeinās lower anterior resection at
Childrenās Hospital Zagreb. The principle of Rehbeinā procedure is to remove aganglionic narrow segment and dilated
sigmoid colon and anastomosis between normal intestine with rectal stump. The postoperative outcome was analysed for
early and late complications like wound infections, abscesses, anastomotic insufficiency, postoperative enterocolitis, constipation,
fecal incontinence, need for reoperation, ileus and mortality. On the basis of our results and data from literature
we concluded that Rehbeinās procedure is an excellent method for treatment Hirschsprungās disease
Paravertebral block: review of the literature
Background: Paravertebral Block (PVB) is an established regional anesthetic technique. It is technically easy to perform and is being used increasingly for intra-operative and post-operative analgesia. This popularity is mainly due to the ease of the technique and fewer complications.
Materials and Methods: This is quantitative systematic review of literature database with the aim to assess the efficacy and safety of Paravertebral block in thoracic, abdominal and breast surgery.
Results: Six randomised control trials that included 386 patients were
reviewed. Authors of reviewed articles reported 100% success in block effectivenes and low incidence of complications.
Conclusion: Paravertebral block is effectiv anesthetic/analgetic technique with very few complications
Serious complications of an obstructive upper airway infection in a young child
A 15-month old boy was admitted to our intensive care unit (ICU) cyanotic, unresponsive, apneic, pulseless, with fixed, dilated pupils and a Glasgow Coma Score (GCS) of 3/15. Prompt cardiopulmonary resuscitation (CPR) was initiated and cardiac function was resumed after 10 minutes. The boy was intubated but could not be ventilated because of a thick, viscous secretion obstructing the trachea and causing total airway obstruction. Bronchoscopy revealed laryngotracheitis as the reason for airway obstruction. A computed tomography (CT) scan of the brain showed diffuse edema and ischemic brain injury, which were considered responsible for the boy\u27s comatose situation. Clinical status remained unchanged for 11 days, after which the boy was transported to another hospital. In children presenting with upper airway obstructing syndromes, not responding to therapy, the diagnosis of bacterial tracheitis should be considered and the child should be monitored in a pediatric intensive care unit
Zbrinjavanje otežanog diÅ”nog puta ā vjeÄni izazov: prikaz bolesnika
Introduction: Obtaining a secured airway is a vital aspect during reconstructive surgery in patients with extensive post-burn mentosternal
scar contractures. Such contractures can potentially lead to a ācanāt intubate, canāt ventilateā scenario, otherwise rare but
life-threatening situation. We present a case of successful management of a paediatric case of anticipated difficult airway due to
burn injury.
Case description: A 14-year-old boy presented for repair of an extensive skin contracture of the neck, thorax and face due to mutilating
scarring. The boy was treated for 80% burn caused by gasoline flame 14 months prior to this surgery. Burn healing and scarring
resulted in massive distortion of the facial and cervical anatomy, all implying difficult airway with a high probability of ācanāt intubate,
canāt ventilateā situation. Flexible fiberoptic bronchoscope with loaded cuffed endotracheal tube NĀ° 6.0 was used for visualisation
of vocal cords through the mouth in light sedation with spontaneous breathing. After visualisation of the vocal cords, fentanyl
(Fentanyl, GlaxoSmithKline) and thiopental (Thiopental, Rotexmedica) were administered and the trachea was intubated at the first
attempt. Balanced general anaesthesia was initiated and planned surgical procedure was successfully completed. The trachea was
extubated on the first postoperative day without any complication.
Conclusion: Difficult paediatric airway and particularly ācanāt intubate, canāt ventilateā situation is a problem associated with significant
risks and complications. Anticipating a difficult airway, having a structured approach with appropriate preparation, and
understanding of difficult airway management algorithms are essential for success.Uvod: Zbrinjavanje diÅ”nog puta od vitalne je važnosti za bolesnika kod kojeg je indiciran rekonstruktivni zahvat nakon opsežnihopeklina lica i vrata. Kontrakture koje nastaju nakon takvih ozljeda mogu dovesti do nemoguÄnosti intubacije i ventilacije, Å”to predstavljarijetku ali životno ugrožavajuÄu situaciju. Prikazati Äemo uspjeÅ”no zbrinjavanje pedijatrijskog bolesnika sa oÄekivano otežanimzbrinjavanjem diÅ”nog puta.Prikaz sluÄaja: ÄetrnaestogodiÅ”nji djeÄak sa opsežnom opeklinom lica, vrata i prsnog koÅ”a bio je predviÄen za rekonstruktivni zahvat.Cijeljenje opekline, koja je nastala 14 mjeseci prije planiranog zahvata, rezultiralo je opsežnom kontrakturom i promjenom anatomijelica i vrata. Radi promijenjenih anatomskih odnosa bilo je oÄekivano da Äe zbrinjavanje diÅ”nog puta biti otežano. Za vizualizacijuglasnica koriÅ”ten je fleksibilni fiberoptiÄki bronhoskop s pripremljenim endotrahealnim tubusom dok je bolesnik bio u plitkoj sedacijii disao spontano. Nakon vizualizacije glasnica bolesnik je dobio fentanil (Fentanyl, GlaxoSmithKline) i tiopental (Thiopental, Rotexmedica)te je potom intubiran iz prvog pokuÅ”aja. Nastavljena je balansirana opÄa anestezija, planirani zahvat je uspjeÅ”no dovrÅ”en.Bolesnik je ekstubiran prvi postoperativni dan bez ikakvih komplikacija.ZakljuÄak: Otežani diÅ”ni put u pedijatrijskih bolesnika je problem povezan s brojnim rizicima i komplikacijama. Prepoznavanje otežanogdiÅ”nog puta uz adekvatnu pripremu i poznavanje algoritama za zbrinjavanje otežanog diÅ”nog puta kljuÄno je za sigurnostbolesnika
Bol i palijativna medicina ā tempus projekt u Hrvatskoj
Pain and Palliative Medicine Project (PPMP), funded by the TEMPUS programme of the European Union, has been established with a goal of sharing knowledge and experience from countries in which palliative care is already substantially developed to partner countries whose palliative care encountered more problems. Croatia as partner country, has tried to improve national palliative care systems through education of medical and non-medical personnel.
Protocols of collaboration and training courses in pain management and palliative medicine at the Universities of Florence and Lyon, including options of collaboration with some university and clinical institutions in Croatia have been presented.
After their two-year project, the Croatian team has noted significant progress in the fields of education, infrastructure and legislative support for development of palliative care. These results show the need for improving Croatian palliative care system as well as possible solutions for overcoming obstacles derived from nationās traditional views on the treatment of the terminally ill.Bol i palijativna medicina (PPMP) je projekt u okviru TEMPUS programa Europske Unije s ciljem prenoÅ”enja znanja i iskustava zemalja, u kojima je palijativna skrb dobro razvijena, zemljama u kojima je palijativna skrb manje aktivna. Hrvatska, kao zemlja partner, nastoji poboljÅ”ati nacionalni program palijativne skrbi kroz edukaciju medicinskog i ne-medicinskog osoblja.
Prikazani su protokoli suradnje i teÄajeva o boli i palijativnoj medicine na SveuÄiliÅ”tima u Firenci i Lyonu, kao i na nekim sveuÄiliÅ”nim i kliniÄkim institucijama u Hrvatskoj.
Nakon dvogodiÅ”njeg projekta hrvatski tim zabilježio je znaÄajni napredak u poljima edukacije, infrastrukture i zakonske potpore razvoju palijativne skrbi. Ovi rezultati su pokazali potrebu za daljnjim poboljÅ”avanjem hrvatske palijativne skrbi kao i moguÄa rjeÅ”enja za prevladavanje prepreka koje proizlaze iz tradicionalnih pogleda druÅ”tva na skrb terminalno bolesnih
Bol i palijativna medicina ā tempus projekt u Hrvatskoj
Pain and Palliative Medicine Project (PPMP), funded by the TEMPUS programme of the European Union, has been established with a goal of sharing knowledge and experience from countries in which palliative care is already substantially developed to partner countries whose palliative care encountered more problems. Croatia as partner country, has tried to improve national palliative care systems through education of medical and non-medical personnel.
Protocols of collaboration and training courses in pain management and palliative medicine at the Universities of Florence and Lyon, including options of collaboration with some university and clinical institutions in Croatia have been presented.
After their two-year project, the Croatian team has noted significant progress in the fields of education, infrastructure and legislative support for development of palliative care. These results show the need for improving Croatian palliative care system as well as possible solutions for overcoming obstacles derived from nationās traditional views on the treatment of the terminally ill.Bol i palijativna medicina (PPMP) je projekt u okviru TEMPUS programa Europske Unije s ciljem prenoÅ”enja znanja i iskustava zemalja, u kojima je palijativna skrb dobro razvijena, zemljama u kojima je palijativna skrb manje aktivna. Hrvatska, kao zemlja partner, nastoji poboljÅ”ati nacionalni program palijativne skrbi kroz edukaciju medicinskog i ne-medicinskog osoblja.
Prikazani su protokoli suradnje i teÄajeva o boli i palijativnoj medicine na SveuÄiliÅ”tima u Firenci i Lyonu, kao i na nekim sveuÄiliÅ”nim i kliniÄkim institucijama u Hrvatskoj.
Nakon dvogodiÅ”njeg projekta hrvatski tim zabilježio je znaÄajni napredak u poljima edukacije, infrastrukture i zakonske potpore razvoju palijativne skrbi. Ovi rezultati su pokazali potrebu za daljnjim poboljÅ”avanjem hrvatske palijativne skrbi kao i moguÄa rjeÅ”enja za prevladavanje prepreka koje proizlaze iz tradicionalnih pogleda druÅ”tva na skrb terminalno bolesnih
AIRWAY MANAGEMENT IN A CHILD WITH EDWARDāS SYNDROME
Prikazujemo zbrinjavanje diÅ”nog puta u djevojÄice s mozaiÄnim tipom Edwardsovog sindroma za planirani zahvat laparotomije u opÄoj anesteziji. Manifestacije Edwardsovog sindroma meÄu ostalima su kraniofacijalne malformacije te je moguÄa otežana ventilacija i intubacija. U naÅ”em sluÄaju djevojÄica je, ovisno o potrebi zahvata, imala postavljeno supraglotiÄno pomagalo tijekom anestezije za dijagnostiÄku pretragu magnetskom rezonancijom (MR), intubirana je fi berbronhoskopski za elektivni zahvat laparoskopije, a u jedinici intenzivne medicine direktnom laringoskopijom. Ventilacija i intubacija protekle su bez komplikacija. Poslijeoperacijski oporavak komplicirao se hipotonijom, pneumonijom te potrebom za reintubacijom i mehaniÄkom ventilacijom.We report on airway management in a girl with mosaic type of Edwardās syndrome for elective surgery, laparotomy in general anesthesia. In Edwardās syndrome, among other manifestations, craniofacial anomalies are expressed and there is a possibility of diffi cult ventilation and intubation. In this case, we secured the airway with supraglottic airway device during diagnostics (anesthesia for magnetic resonance imaging), we performed fi beroptic intubation for elective laparoscopy, and in the intensive care unit, she was intubated with direct laryngoscopy. Ventilation and intubation were accomplished without problems. Postoperative recovery was complicated with hypotonia, pneumonia and the need of reintubation and mechanical ventilation
DELIRIUM INCIDENCE IN PEDIATRIC INTENSIVE CARE UNIT
Delirij je ozbiljan neuropsihijatrijski poremeÄaj a delirij djece u jedinicama intenzivnog lijeÄenja je kao kliniÄki entitet neprepoznat. Rana dijagnoza delirija djece važna je zbog pravovremene terapije i raznih psihosocijalnih postupaka. Dijagnostika delirija u djeÄjoj populaciji je otežana jer postoji viÅ”e ljestvica i testova ali niti jedan nije dovoljno specifiÄan i osjetljiv za procjenu mentalnog statusa djece u jedinicama intenzivnog lijeÄenja. Algoritam za dijagnostiku i lijeÄenje delirija djece u jedinicama intenzivnog lijeÄenja ne postoji te je potrebno dodatnih kliniÄkih ispitivanja i radova radi poboljÅ”anja dijagnostike i terapije tog ozbiljnog kliniÄkog entiteta.Delirium is a serious neuropsychiatric disorder and pediatric delirium (PD) is a similarly serious condition. PD is understudied and very often misdiagnosed, especially in pediatric intensive care units (PICU). It is important to early diagnose PD, so that early psychosocial interventions and therapy can be introduced. Valid diagnostic instruments are needed at PICU to assess PD. There
are many scales and tests to diagnose delirium but none of them is specific enough to diagnose PD. Although PD is a serious complication at PICU, clinical guidelines for PD are still lacking, therefore additional investigations are needed to bring them out